In its 16-page ruling, the appeals court thus upheld a decision by the Quebec Superior Court that ruled earlier in November that Sainte-Justine Hospital could permanently remove a breathing tube from the child because it considered the risks involved were outweighed with intubation the expected benefits.
The boy has been in a coma since June 12 after being found at the bottom of the family pool where he suffered a prolonged cardiac arrest. Doctors believe the child is able to breathe on his own, but he is battling a variety of problems, including acute respiratory distress syndrome, cardiac dysfunction and seizures.
Sainte-Justine Hospital has gone to court because the child’s parents refuse to consent to the procedure unless doctors consider reintubating the child if something goes wrong.
After hearing several doctors and the parents, the Court of Appeal comes to the conclusion that the experts consulted agree that the proposed treatment plan is in the interest of the child. […] and conforms to good medical practice, even if this could indirectly lead to the death of the child.
“Even if this observation may be obviously difficult for parents to accept as human beings, it is nevertheless in accordance with the law since, according to the medical evidence presented, it is primarily in the interest of the child. »
— A quote from an extract from the judgment of the court of appeal
Medical professionals have repeatedly argued that this mechanical ventilation is contraindicated for his condition. This could cause serious harm or even death to the child.
However, doctors say the child should receive end-of-life care if he is unable to breathe unaided, the hospital argues.
In his testimony before the Court of Appeals, Dr. Baruch Toledano, a pediatrician who is part of a group of 14 intensive care doctors who have taken turns at the child’s bedside since his arrival in the ICU, states that the child can breathe on his own and that the presence of the tube not only puts him at risk of serious complications such as Muscle deconditioning, bedsores, inflammation of the vocal cords, the development of pneumonia and tracheitis, but also causes him discomfort and pain.
In his opinion, the advantages of extubation are numerous, since in particular it allows the child to be mobilized, which will make it possible to consider a return home, as the parents wish.
ethically justifiable
The judge also heard the opinion of clinical ethicist Marie-Claude Levasseur, whose report concludes that in the event of a failed extubation, it would be ethical not to re-intubate the child given the serious and irreversible damage it is suffering .
According to the appeals court’s court document, the child’s parents spoke with great candidness about their beliefs and their hopes of seeing their child alive and possibly emerging from his coma.
But for all the empathy one might have for them, their hope is not based on scientific data, rather all medical evidence shows that assisted ventilation is causing their child suffering, the text adds […] and that the child will inevitably die in the short term, even if left intubated or reintubated.
“It is not the child’s survival at all costs that must be considered here, but his interest in living or even surviving in conditions that are considered unacceptable because they are suffering and have no way out. »
— A quote from an extract from the judgment of the court of appeal
Finally, the judgment recalls that, as the doctors claim, the risk of death of the child is not directly related to the extubation.
Unfortunately, if death does occur, it is the inevitable result of severe irreversible neurological damage to the child, rather than removal of the mechanical ventilator, since extubation is just the maneuver that will confirm whether or not his condition is compatible with life, we read in the document.